Instant Expert: HIV Today

The development of powerful drug regimens that can virtually eliminate HIV replication is arguably one of medicine’s greatest success stories; an HIV infection no longer has to be a death sentence. But infection rates are still breathtakingly high in many parts of Africa, reaching over 15 per cent of adults in countries such as South Africa and Zimbabwe. Now the challenge is to fund drug treatment for all who need it while cutting the number of new infections.

Politics of aids

The early history of AIDS has shaped perception and treatment of today’s epidemic in important ways. It emerged among gay men, who were widely regarded as immoral by the homophobic majority in the US. The addition of prostitutes and heroin addicts to the list of high-risk groups did little to increase public sympathy, so at first funding for prevention and care remained scarce.

To reduce discrimination against people with HIV and to try and stop it spreading, activists and many in the public health establishment tried to create a sense of shared risk&colon; the mantra was “Anyone can get HIV”. When the epidemic took off among straight people in Africa, the difficulty of confronting the different patterns of sexual relationships became clear. So people working in the HIV industry took the spotlight off the controversial issues of sex and drugs by emphasising the social dimensions of the epidemic. It was packaged as a problem not so much of unprotected sex but of underdevelopment, poverty, gender inequality, human rights and much else.

The strategy certainly brought in more cash&colon; funding for HIV prevention and treatment …